JP2009526579A - Device, clip, endoscope, and method for intracavitary treatment of tissues such as hemorrhoids - Google Patents

Abstract

An intraluminal treatment device for tissue is provided.
A tissue intraluminal treatment device includes a handle, a shaft extending from the handle, and a head disposed at a distal end of the shaft, the head including at least one jaw, The jaws are movable between an open position defining a window for inserting tissue and surrounding tissue and a closed position, and the shaft is in a curved longitudinal direction between the handle and the head. Extend along.
[Selection] Figure 3

Description

Disclosure details

  The present invention relates to a device, clip, for intraluminal treatment of body tissue, for example for transanal treatment of hemorrhoids, or for intraluminal treatment or endoscopic treatment of body tissue other than hemorrhoids. , Anoscope and method.

  Furthermore, it is an object of the present invention to provide an endoscope, for example an anoscope for minimally invasive surgical treatment of hemorrhoids, for example to treat lesions in the lower rectum.

  Apart from endoscopic or intracavitary treatment of body tissues different from hemorrhoids, such aspects of the present invention are so-called “in the body”, ie above the anorectal transition (comb line). Especially correlated with the realization of minimally invasive surgical treatment for treating hemorrhoids.

  One known method of hemorrhoid surgical treatment is a method of ligation of hemorrhoids using a rubber elastic band, in which each hemorrhoid is inserted into a hollow cylindrical device and a rubber elastic band is formed. Positioned around the hemorrhoids. The compression applied by the rubber elastic band leads to the necrosis of the tissue and thus to the shedding.

  Such a method has several drawbacks with the equipment used. More specifically, the rubber elastic band cannot be positioned deeply at the base of the hemorrhoid, and the rubber elastic band tends to follow the shape of the tissue due to its elastic properties, The surgical treatment cannot be thorough.

  A further method is the method known as PPH, together with the corresponding application device of the method. The device generally consists of a circular stapler that is configured to be inserted into the anal canal, stapled, and cut the ring of tissue that constitutes the hemorrhoid. In this case, the cut affects all parts of the anal canal, resulting in a rather large wound.

  The problem underlying the present invention is for intraluminal treatment of body tissues, for example for transanal treatment of hemorrhoids, or for intraluminal treatment of body tissues different from hemorrhoids, ie endoscopic treatment An apparatus, clip, and method for providing a device, clip, and method having structural and functional characteristics to overcome the disadvantages described above with respect to the prior art.

  Such a problem is a device for intraluminal treatment of body tissue, for example for transanal treatment of hemorrhoids according to claim 1 or 16 or for intraluminal treatment or endoscopic treatment of body tissues different from hemorrhoids. Clips for intraluminal treatment of body tissue by means of an apparatus for mirror treatment, for example for intraanal treatment or internal treatment of body tissue for transanal treatment of hemorrhoids according to claim 7 or different from hemorrhoids With a clip for endoscopic treatment and for a method for intracavitary treatment of body tissue, for example a transanal treatment method for hemorrhoids according to claim 21 or 42 or in a body tissue cavity different from hemorrhoids That is, it is solved by an endoscopic treatment method.

  A further problem underlying the present invention is to provide, for example, an endoscope such as an anoscope for easy and effective use, such as transanal treatment of hemorrhoids or a different body from hemorrhoids. By providing an endoscope, eg, for use with an apparatus as described above, configured for use in a method of endoluminal treatment of tissue, in particular endoluminal treatment of body tissue, in particular. is there.

  Such a problem is due to a lesion in the lower rectum, such as an endoscope for treating lesions of the natural duct of the human or animal body, for example for minimally invasive surgical treatment of hemorrhoids according to claim 28. It is solved by the anoscope.

  Further features and advantages of the device, clip, endoscope or anoscope, and method according to the invention relate to the preferred embodiment (application in the treatment of hemorrhoids, but are intended to be limited to such application) It should be more apparent from the following description, but the embodiments are illustrative with reference to the accompanying drawings and are not limiting.

  With reference to the accompanying drawings, an apparatus for transanal treatment of hemorrhoids is indicated generally at 10.

  Such a device includes a handle 12 and a shaft 14 extending from the handle. A head 16 is disposed at the distal end of the shaft, i.e., at the end remote from the surgeon or operator holding and operating the device.

  The head 16 includes at least one jaw 18 that is movable between an open position and a closed position where the jaw 18 defines a window 20 for insertion of hemorrhoids and surrounding tissue. .

  Based on the preferred embodiment shown in the drawings, the window 20 opens laterally in the open position of the jaws 18.

  A jaw opposite the movable jaw is indicated at 22. In the illustrated example, the opposite jaw 22 is fixed and is located distally with respect to the movable jaw. Based on different embodiments, both jaws can be considered movable, or the position of the movable jaw and the opposite jaw is reversed and the movable jaw is distal with respect to the opposite jaw. It can be considered in position.

  Preferably, the shaft 14 may extend in a curved longitudinal direction between the handle and the head.

  Preferably, the head, in particular the two jaws, has a curved structure.

  In some embodiments of the present invention, the device 10 is a linear or slightly curved stapler. The head includes at least one row of clip elements or staples 24 that can be fastened to the hemorrhoid and surrounding tissue to coagulate the tissue and achieve blood flow blockage. Preferably, the staple is fastened to the hemorrhoid after the head has moved from the open position to the closed position. More particularly, the handle has first means for closing the jaws and second means for securing the staples to the tissue. In another embodiment, the staples are fastened to the tissue by movement of the head from an open position to a closed position.

  Preferably, at least two rows 24 of clip elements are conceivable, the at least two rows 24 of clip elements being arranged substantially parallel to each other. Alternatively, there may be more than two rows of clip elements.

  In the example shown, the clip element is arranged in a movable jaw 18. The opposite jaw forces the clip element to bend and adhere to tissue as the head moves from the open position to the closed position.

  Based on possible embodiments, it is further conceivable that the knife 26 is adjacent to the clip elements of at least one row 24 to cut the hemorrhoid and surrounding tissue. Preferably, the knife is positioned adjacent to a row of staples suitable for being secured to tissue on the side of the anal canal. The knife is suitable for cutting tissue on the side of the hemorrhoid so that the hemorrhoid itself does not have any rows of staples. Thus, the anal canal tissue is coagulated by the staples to achieve blockage of blood flow. In different embodiments, if more than two rows of 24 clip elements are used, the knives may be placed between the two rows and the first line of stapling is in tissue. The second line of stapling belongs to the anal canal tissue.

  According to a different embodiment, the device 10 includes a head configured to receive at least one clip 28 and to tighten the clip 28 around the hemorrhoid through the window. In other words, the head may be curvilinear and is implemented with a single clip between the jaws, without a plurality of clip elements or staples.

  Alternatively, the head further includes a knife 26 for cutting the hemorrhoids and surrounding tissue compressed by the clip.

  Clip 28 for hemorrhoid transanal treatment includes two complementary elements 30, 32 that are configured to be secured together in at least one compression position of the hemorrhoid and surrounding tissue. Has been. Preferably, clip 28 includes two complementary curvilinear elements 30, 32 that are configured to be received within the head of a device for transanal treatment of hemorrhoids as described above.

  In accordance with the first embodiment, the clip 28 is provided with a first element 30 provided with at least one fixing pin 34 configured to be inserted into a corresponding seat 36 of the second element 32. including. The seat 36 includes at least one elastic element 38 and the fixing pin 34 is shaped to be snap-locked within the seat 36.

  Alternatively, the first element 30 and the second element 32 each include a guide 40 and a sliding seat 42 for positioning the two elements 30, 32 relative to each other.

  Preferably, the complementary elements 30, 32 have a mutual compression portion 44 for the hemorrhoid and surrounding tissue. Based on the first embodiment, the compression portion is configured to cause tissue necrosis if the use of knife 26 is not contemplated.

  According to the second embodiment, the complementary elements 30, 32 are hinged to each other and are preferably closed by at least one elastic element 46 arranged on the hinge 48. It is kept in. During insertion, the complementary elements 30, 32 are kept open by the jaws of the head.

  Again, it is conceivable that the mutual compression portion 44 acts as a snap-clasping to confine the hemorrhoid and surrounding tissue.

  Preferably, in both examples described and illustrated, it is contemplated that at least a portion of the complementary elements 30, 32 are realized with a biocompatible material. Preferably, the portion of biocompatible material is located in a clasping or connection zone (pin or hinge for clip type) between two complementary elements.

  In accordance with a further embodiment, the present invention relates to a device 10 for hemorrhoid transanal treatment, which device is disposed at a handle 12, a shaft 14 extending from the handle 12, and a distal end of the shaft. A head 16. The head 16 includes at least one jaw 18 that is movable between an open position and a closed position where the jaw 18 defines a window 20 for insertion of the hemorrhoid and surrounding tissue. . More specifically, the head is implemented as described above, i.e., the head includes a jaw 22 opposite a movable jaw. In the illustrated example, the opposite jaw is fixed and located on the distal side with respect to the movable jaw. Even in this case, both jaws are movable, or otherwise the position of the movable jaw and the opposite jaw is reversed and the movable jaw is on the distal side with respect to the opposite jaw It is possible.

  Based on this embodiment, the head does not consider the presence of clip elements. Rather, the shaft and head preferably include means 50 for applying energy to the hemorrhoid and surrounding tissue to cut and coagulate the tissue. Based on this embodiment, the shaft may extend in a curved longitudinal direction between the handle and the head. Furthermore, the bed, in particular the jaws, may have a curvilinear structure.

  According to the first embodiment, the means for applying energy includes ultrasonic means. Alternatively, the means for applying energy includes laser means.

  Based on further features, the present invention relates to a method for transanal treatment of hemorrhoids.

In general, the method is
Positioning the device 10 for transanal treatment of hemorrhoids according to one of the above embodiments and locally placing the head 16 in one hemorrhoid;
Grasping and pulling the hemorrhoid through a window 20 defined by the head 16 of the device for transanal treatment of the hemorrhoid;
Closing the jaws 18, 22 to fix the hemorrhoid and surrounding tissue;
Joining the portions of tissue in a region where the tissue is fixed between the jaws.

  Further, the process of cutting the tissue through the jaws and removing the tissue from the site may be suitably considered.

  Based on possible embodiments, the portions of tissue are joined in an area where the tissue is secured between the jaws by at least one row of clip elements or staples. The staples are preferably fastened to the tissue after the jaws have moved from the open position to the closed position.

  According to another embodiment, the tissue portions are joined in the region where the tissue is secured between the jaws by positioning one clip as described above.

  According to a further embodiment, the tissue portion is the region where the tissue is fixed between the jaws while simultaneously cutting the tissue by applying energy, preferably by applying ultrasound or laser, Combined.

  In the following, the transanal treatment method for hemorrhoids according to the present invention will be described in detail.

  The patient is prepared and positioned for surgery, perhaps in the usual manner or based on surgeon preference. Normal preparation of the operating area is also performed, for example, continuing anesthesia such as spinal or general anesthesia.

  Visual inspection is performed on the anal canal and perianal tissue, followed by digital rectal examination to confirm and classify internal hemorrhoids, possibly examining additional lesions and adding Pay attention to typical lesions.

  Next, an anoscope is inserted.

  The internal hemorrhoid is grasped by forceps, for example, and locates an unaffected area of the patient's body.

  Next, a device for transanal treatment of hemorrhoids is inserted and the hemorrhoid is pulled through the window of the device itself. The jaws are then closed, thus fixing the hemorrhoid and surrounding tissue.

  If the device is a stapler as described above, preferably after closing the jaws, the clip element is inserted through the tissue and closed, and the knife is activated to cut the hemorrhoid. The removed tissue is removed. Preferably, the staple is fastened to the anal canal tissue to coagulate at least that portion of the tissue.

  In the case where a single clip is used, as described above, the clip is pre-positioned in the open window and the tissue is pulled through the window and the open clip. When the jaw is closed, the clip is secured to the hemorrhoid. In this case, it is conceivable that the device also includes a knife, and therefore the tissue pressed by the clip is cut and removed. Alternatively, the tissue is not cut and the tissue is removed by necrosis of the compressed area. In the case of using portions of biocompatible material, the clip can be taken or absorbed once it has served its purpose.

  Finally, in the case of means for applying energy, after the jaws are closed, such means (laser or ultrasound) are activated to cauterize and cut tissue.

  The device is then removed, possibly with the removed tissue.

  The hemorrhoid is then examined at the cut site and the anorectal junction. If the test is satisfactory, the anoscope can be removed.

  Finally, a sponge is inserted into the rectum.

  According to a further aspect, the present invention relates to an anoscope for treating a lesion of the lower rectum, for example, more specifically for treating hemorrhoids as described above.

  An anoscope according to the present invention is shown at 52 and includes an insertion portion 54 and an extracorporeal or grip portion 56.

  The insertion portion includes a generally tubular wall extending from the proximal section 54a to the distal section 54b. Distal section 54b is preferably realized in a frustoconical shape, with smaller section, with a smaller section truncated at the distal end of the anoscope.

  Furthermore, the tubular wall includes a window 58, which is configured, for example, to visualize hemorrhoids and to use the instrument described above. More particularly, the window 58 includes a central section 54c and a distal section 54b of the insertion portion that open at the distal end of the anoscope. Preferably, the window 58 does not extend to the proximal section 54a of the insertion portion. In other words, the proximal section 54a extends continuously in the circumferential direction over 360 degrees to protect the anorectal junction during surgery.

  According to a possible embodiment, the window 58 has a curved edge at least in the central section 54c of the insertion portion, and the window 58 is far from the proximal section of the anoscope at least until the start of the distal section. Slightly spread as you move to the top section.

  Preferably, based on possible embodiments, the insertion portion has a diameter that varies from the proximal section to the distal section, at least to the beginning of the distal section. More specifically, the lateral dimension d2 (diameter) measured at the start of the proximal section is the start of the distal section (the term “start” refers to the movement of the anoscope from the proximal section to the distal section). Shorter than the transverse dimension d1 (diameter) measured in (used).

  The transition from dimension d1 to dimension d2 may be achieved by a curved contour, or more preferably by a linear contour.

  Preferably, the anoscope is made of a transparent material so that the anorectal transition is always observed.

  With respect to the grip portion 56, at least two flanges 60 are preferably envisaged, the flange 60 extending laterally with respect to the longitudinal extension of the insertion portion, for operating the anoscope and possibly for the anal / rectal wall. It can be turned along the circumference. Preferably, it is conceivable that two flanges facing oppositely and slightly displaced are on one side of the anoscope.

  The dimensions of the anoscope, and more particularly the dimensions of the insertion section, are such that the instrument can be used and prevent sphincter damage.

Regarding the use of the anoscope and, more particularly, the use of the anoscope described above, the above-described methods for transanal treatment of hemorrhoids more particularly
The process of preparing the patient and the operating area;
For example, the process of moving to anesthesia such as spinal or general anesthesia,
Performing a visual examination of the anal canal and surrounding tissues, followed by a digital rectal examination to identify and classify internal hemorrhoids;
The process of inserting an anoscope, in particular an anoscope as described above,
Gripping the hemorrhoid through the window by positioning the window 58 in the hemorrhoid and inserting the gripping means 62 through the anoscope and the window;
Preferably, the process of locating an unaffected area of the patient;
Inserting a device for transanal treatment of hemorrhoids, more specifically as described above, inside the anoscope and projecting the head 16 through the window 58;
Pulling hemorrhoids through anoscope windows and device windows;
Closing the jaws and fixing the hemorrhoids and surrounding tissue,
Can be considered.

  As noted above, when the device is a stapler, the clip element or staple is inserted into the tissue and closed, and the knife is preferably activated after the head has moved from the open position to the closed position. Cut the hemorrhoids. The removed tissue is removed by withdrawing the tissue from the anoscope.

  As noted above, when a single clip is used, the clip is pre-positioned in the open window and tissue is pulled through the anoscope window, the device window, and the open clip. Closing the jaws secures the clip to the hemorrhoid. In this case, it is conceivable that the device further comprises a knife, so that the tissue compressed by the clip is cut and removed through the anoscope. Alternatively, the tissue is not cut and the tissue is removed by necrosis of the compressed area. In the case where portions of biocompatible material are used, the clip is either taken off or absorbed once it has fulfilled its role.

  Finally, in the case of means for applying energy, after the jaws are closed, such means (laser or ultrasound) are activated to cauterize and cut tissue.

  The device is then removed, possibly with the removed tissue, and the anoscope is subsequently removed. Perhaps a sponge is inserted into the rectum.

  From the above description, by considering the method according to the present invention, it is reasonably appreciated that more thorough results can be obtained without creating large wounds all around the anal canal. Will.

  The devices, clips and anoscopes described above allow for simplified treatment and reduced patient risk. In addition, the devices, clips, and anoscope described above operate in several successive steps to allow removal of any hemorrhoids and possibly prevent excessive discomfort to the patient.

  The staple row or clip is configured to be correctly positioned. With hemorrhoid traction, the staple row or clip may further be positioned deeper with respect to the use of the elastic band. Furthermore, the position of the staple row or clip is ensured and stable during or after the operation.

  Obviously, variations and / or additions to the embodiments described and illustrated above will be envisaged.

  For example, the device may extend along a curved longitudinal direction that includes one or more curved portions.

  Although preferred embodiments of the devices, clips, methods or anoscopes described above have been described in the context of hemorrhoid treatment, these are generally described as intraluminal treatment of body tissue, such as hemorrhoids. Are also suitable for the treatment of different body tissues, and those skilled in the art will be able to make various modifications, adaptations, and modifications to meet accidental and specific needs without departing from the scope of the appended claims. Further, replacement of an element with another functionally equivalent element may be performed.

Embodiment
(1) In a device for intraluminal treatment of body tissue,
A handle,
A shaft extending from the handle;
A head disposed at a distal end of the shaft;
Including
The head includes at least one jaw;
The jaws are movable between an open position and a closed position defining a window through which the tissue to be treated is inserted;
The apparatus, wherein the shaft extends in a curved longitudinal direction between the handle and the head.
(2) In the apparatus according to the embodiment (1),
The head has a curved structure.
(3) In the apparatus according to the embodiment (1),
The device is a linear or slightly curved stapler,
The head includes at least one row of clip elements or staples;
The apparatus wherein the clip element or staple is capable of being clamped to the tissue to be treated and surrounding tissue to coagulate the tissue and achieve blood flow blockage.
(4) In the apparatus according to the embodiment (3),
A knife adjacent to the at least one row of clip elements or staples for cutting the tissue to be treated and the surrounding tissue on the side of the tissue;
Further including
The apparatus wherein the tissue of the native duct is coagulated by the staple row to achieve blood flow blockage.
(5) In the apparatus according to the embodiment (1),
The apparatus, wherein the head is configured to receive at least one clip and to secure the clip to the tissue to be treated through the window.
(6) In the apparatus according to the embodiment (5),
The head is
The tissue to be treated, compressed by the clip, and a knife for cutting the surrounding tissue,
Further comprising an apparatus.
(7) In a clip for intraluminal treatment of body tissue,
Two complementary elements configured to be secured together in at least one compressed position of the tissue to be treated and adjacent tissue;
Including a clip.
(8) In the clip according to the embodiment (7),
Two curved complementary elements configured to be received within the head of the device for endoluminal treatment of tissue according to any of embodiments (1) to (6);
Including a clip.
(9) In the clip according to the embodiment (7),
The first element includes at least one securing pin configured to be inserted into a corresponding seat of the second element;
The seat comprises at least one elastic element;
A clip, wherein the pin is shaped to be secured by snap fit within the seat.
(10) In the clip according to the embodiment (9),
The clip, wherein the first and second elements include respective guides and a sliding seat for positioning the two elements relative to each other.

(11) In the clip according to the embodiment (7),
The clip, wherein the complementary element includes a mutual compression portion for the tissue to be treated and surrounding tissue.
(12) In the clip according to the embodiment (7),
A clip, wherein the complementary elements are hinged to each other and kept closed by at least one elastic element, preferably arranged on the hinge.
(13) In the clip according to the embodiment (12),
The complementary element is
An inter-compression or snap-fit clasp portion to confine the tissue to be treated and the surrounding tissue;
Including a clip.
(14) In the clip according to the embodiment (7),
A clip, wherein at least a portion of the complementary element is realized with a bioabsorbable material.
(15) In the clip according to the embodiment (14),
A clip, wherein a portion of the bioabsorbable material is disposed in a clasp or connection region between the two complementary elements.
(16) In an apparatus for intraluminal treatment of body tissue,
A handle,
A shaft extending from the handle;
A head disposed at a distal end of the shaft;
Including
The head includes at least one jaw;
The jaws are movable between an open position and a closed position defining a window for the jaws and surrounding tissue to be treated to be inserted;
The apparatus wherein the shaft and the head include means for applying energy to the tissue to be treated and the surrounding tissue to cut and coagulate the tissue.
(17) In the device according to the embodiment (16),
The apparatus, wherein the shaft extends in a curvilinear longitudinal direction between the handle and the head.
(18) In the device according to the embodiment (16),
The head has a curved structure.
(19) In the device according to the embodiment (16),
The apparatus wherein the means for applying energy comprises ultrasonic means.
(20) In the device according to embodiment (16),
The apparatus wherein the means for applying energy comprises laser means.

(21) In a method for intracavitary treatment of body tissue,
The device according to any of the embodiments (1) to (6) or (16) to (20) is positioned in the tissue to be treated, and the head is locally disposed in one tissue The process of
Grasping and pulling the tissue through the window defined by the head of the device;
Closing the jaws and fixing the tissue and surrounding tissue;
Joining the portions of the tissue in an area where the tissue is secured between the jaws;
Including a method.
(22) In the method according to embodiment (21),
Cutting the tissue through the jaws and removing the cut tissue from the site;
Further comprising a method.
(23) In the method according to embodiment (21),
The method wherein the portions of tissue are joined in an area where the tissue is secured between the jaws by at least one row of clip elements or staples.
(24) In the method according to embodiment (23),
The method wherein the staple is clamped to the tissue to be treated after the head has moved from an open position to a closed position.
(25) In the method according to embodiment (24),
The method wherein the tissue is cut through the jaws when the staple is fastened to the tissue to be treated.
(26) In the method according to embodiment (21),
The method wherein the portions of tissue are joined at an area where the tissue is secured between the jaws by positioning one clip according to any of embodiments (7) to (15).
(27) In the method according to embodiment (21),
The portions of the tissue are joined in a region where the tissue is secured between the jaws by applying energy, preferably applying ultrasound or laser, while simultaneously cutting and coagulating the tissue. The way.
(28) In an endoscope (52) for treating lesions of the natural duct of the human or animal body, in particular for transanal treatment of hemorrhoids,
An insertion portion (54);
An extracorporeal or grip portion (56);
Including
The insertion portion includes a generally tubular wall extending from the proximal section (54a) to the distal section (54b);
Endoscope, wherein the distal section is realized as a truncated cone with a smaller section truncated at the distal end of the anoscope.
(29) In the endoscope according to the embodiment (28),
Endoscope, wherein the tubular wall includes, for example, a window (58) configured to visualize the tissue to be treated and so that an instrument can be used.
(30) In the endoscope according to the embodiment (29),
The window (58)
A central section (54c) and a distal section (54b) of the insertion portion opened at the distal end of the endoscope;
An endoscope comprising:

(31) In the endoscope according to the embodiment (30),
Endoscope, wherein the window (58) does not extend to the proximal section (54a) of the insertion portion.
(32) In the endoscope according to the embodiment (30),
Endoscope, wherein the proximal section (54a) extends continuously in the circumferential direction over 360 degrees.
(33) In the endoscope according to the embodiment (29),
The window (58) has a curvilinear edge at least in the central section (54c) of the insertion portion;
Endoscope, wherein the window (58) extends slightly as it moves from the proximal section of the endoscope to the distal section, at least to the beginning of the distal section.
(34) In the endoscope according to the embodiment (29),
The endoscope, wherein the insertion portion has a diameter that varies from the proximal section to the distal section, at least up to the start of the distal section.
(35) In the endoscope according to the embodiment (34),
The lateral dimension (d2) measured at the start of the proximal section was measured at the start of the distal section as it moved from the proximal section of the endoscope to the distal section. An endoscope that is smaller than the lateral dimension (d1).
(36) In the endoscope according to the embodiment (35),
The transition from the dimension (d1) measured at the start of the distal section to the dimension (d2) measured at the start of the proximal section is obtained by a curved contour. mirror.
(37) In the endoscope according to the embodiment (35),
The transition from the dimension (d1) measured at the start of the distal section to the dimension (d2) measured at the start of the proximal section is obtained by a linear contour. mirror.
(38) In the endoscope according to the embodiment (28),
An endoscope that is made of a transparent material.
(39) In the endoscope according to the embodiment (28),
The grip portion (56) includes at least two flanges (60) extending laterally with respect to the longitudinal extension of the insertion portion to manipulate the endoscope and possibly the wall of the native conduit. An endoscope that can be swung along a circumference.
(40) In the endoscope according to the embodiment (39),
An endoscope in which two flanges facing oppositely and slightly displaced are provided on one side of the endoscope.

(41) In the endoscope according to the embodiment (28),
The dimensions of the endoscope, and more particularly the dimensions of the insertion portion, are adapted to allow the use of instruments and to prevent damage to muscles (eg sphincter) around the duct. An endoscope.
(42) In a method for intracavitary treatment of body tissue,
The process of positioning and preparing the patient and operating area;
For example, the process of moving to anesthesia such as spinal or general anesthesia,
Visual and / or finger examination of the natural duct and the tissue to be treated;
Including the window (58), for example, inserting the endoscope according to any of embodiments (28) to (41);
Inserting grasping means (62) or forceps into the endoscope, grasping the tissue to be treated through the window (58), and preferably locating the insensitive area of the patient; ,
For example, the device for intraluminal treatment of body tissue according to any one of the embodiments (1) to (6) or (16) to (20) is inserted into the endoscope. Process,
Pulling the tissue to be treated through the endoscope window (58) and through the device window (20);
Closing the jaws (18, 22) of the device and thus fixing the tissue and surrounding tissue;
Including a method.
(43) In the method according to embodiment (42),
The method, wherein the device is a stapler.
(44) In the method according to embodiment (43),
A method wherein insertion of a clip element or staple into the tissue is performed after the jaws are closed.
(45) In the method according to embodiment (44),
Actuation of the knife to cut the tissue is performed while a clip element or staple is inserted into the tissue,
The method wherein the tissue is cut adjacent to at least one row of staples inserted into the native conduit so that the excised tissue is removed.
(46) In the method according to embodiment (42),
The device holds a pre-positioned clip in the open window of the device;
The tissue is pulled through the window of the endoscope, the window of the device, and the clip open;
Closing the jaws secures the clip to the tissue.
(47) In the method according to embodiment (46),
The apparatus further comprises a knife;
The method wherein the tissue compressed by the clip is cut and removed.
(48) In the method according to embodiment (46),
The method wherein the tissue is not cut and the tissue is removed by necrosis of the compressed area.
(49) In the method according to embodiment (42),
A method wherein, after the jaws are closed, the means for applying energy (eg, laser or ultrasound) is activated to cauterize and cut the tissue.
(50) In the method according to embodiment (42),
The method wherein the device and endoscope are removed upon completion of the method.

(51) In the method according to embodiment (50),
A method wherein a sponge is inserted into the native conduit after the device and endoscope have been removed.

1 is a perspective view of an embodiment of a device for transanal treatment of hemorrhoids. FIG. FIG. 2 is an enlarged detail view of the apparatus of FIG. 1. 2 is an enlarged detail view of a possible embodiment of the apparatus of FIG. FIG. 4 is a detailed view of the apparatus of FIG. 3 from a different angle. FIG. 4 is a detail view of FIG. 3 from different angles associated with an anoscope according to the present invention. FIG. 6 is a detailed view of the anoscope and device of FIG. 5 from a different angle. 1 is a perspective view of an anoscope according to the present invention. FIG. It is a side view of the anoscope of FIG. It is a perspective view of the anoscope of FIG. FIG. 3 is an exploded perspective view of a possible embodiment of a clip according to the present invention. FIG. 2 is a perspective view of a possible embodiment of a clip according to the present invention in a first state of use. FIG. 12 shows the clip of FIG. 11 in a second state during use. FIG. 2 is an enlarged view of a possible embodiment of details of the apparatus of the present invention. It is a cross-sectional view of an anal canal. It is a longitudinal cross-sectional view of an anal canal. FIG. 16 shows the details of FIG. 15 in one of a series of steps of the method according to the invention. FIG. 16 shows the details of FIG. 15 in one of a series of steps of the method according to the invention. FIG. 16 shows the details of FIG. 15 in one of a series of steps of the method according to the invention.

Claims (13)

In an apparatus for intraluminal treatment of body tissue,
A handle,
A shaft extending from the handle;
A head disposed at a distal end of the shaft;
Including
The head includes at least one jaw;
The jaws are movable between an open position and a closed position defining a window through which the tissue to be treated is inserted;
The apparatus, wherein the shaft extends in a curved longitudinal direction between the handle and the head. The apparatus of claim 1.
The head has a curved structure. The apparatus of claim 1.
The device is a linear or slightly curved stapler,
The head includes at least one row of clip elements or staples;
The apparatus wherein the clip element or staple is capable of being clamped to the tissue to be treated and surrounding tissue to coagulate the tissue and achieve blood flow blockage. The apparatus of claim 3.
Further comprising a knife adjacent to the tissue to be treated and the at least one row of clip elements or staples for cutting the surrounding tissue on the side of the tissue;
The apparatus wherein the tissue of the native duct is coagulated by the staple row to achieve blood flow blockage. The apparatus of claim 1.
The apparatus, wherein the head is configured to receive at least one clip and to secure the clip to the tissue to be treated through the window. The apparatus of claim 5.
The head is
The tissue to be treated, compressed by the clip, and a knife for cutting the surrounding tissue,
Further comprising an apparatus. In a clip for intraluminal treatment of body tissue,
Two complementary elements configured to be secured together in at least one compressed position of the tissue to be treated and adjacent tissue;
Including a clip. The clip according to claim 7,
Two curvilinear complementary elements configured to be received in the head of a device for endoluminal treatment of tissue according to any of claims 1 to 6;
Including a clip. The clip according to claim 7,
The first element includes at least one securing pin configured to be inserted into a corresponding seat of the second element;
The seat comprises at least one elastic element;
A clip, wherein the pin is shaped to be secured by snap fit within the seat. The clip according to claim 9,
The clip, wherein the first and second elements include respective guides and a sliding seat for positioning the two elements relative to each other. In an apparatus for intraluminal treatment of body tissue,
A handle,
A shaft extending from the handle;
A head disposed at a distal end of the shaft;
Including
The head includes at least one jaw;
The jaws are movable between an open position and a closed position that define a window through which the tissue to be treated and surrounding tissue is inserted;
The apparatus wherein the shaft and the head include means for applying energy to the tissue to be treated and the surrounding tissue to cut and coagulate the tissue. In a method for endoluminal treatment of body tissue,
Positioning the device according to any of claims 1-6 or 11 to the tissue to be treated and locally placing the head in one tissue;
Grasping and pulling the tissue through the window defined by the head of the device;
Closing the jaws and fixing the tissue and surrounding tissue;
Joining the portions of the tissue in an area where the tissue is secured between the jaws;
Including a method. In an endoscope (52) for treating lesions of the natural ducts of the human or animal body, in particular for transanal treatment of hemorrhoids,
An insertion portion (54);
An extracorporeal or grip portion (56);
Including
The insertion portion includes a generally tubular wall extending from the proximal section (54a) to the distal section (54b);
Endoscope, wherein the distal section is realized as a truncated cone with a smaller section truncated at the distal end of the anoscope.

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